Rental Energy App

Return the completed application to: Center for Energy and Environment 212 3rd Avenue North, Suite 560 Minneapolis, MN 55401 (612) 335-5885

Rental Energy Loan Fund Application 1. I am applying for a loan of $________________ for _________months. No part of the proceeds of this loan will be used to pay any existing loan or mortgage.

2. Have you ever received an energy improvement loan? __Yes __No a. Date of the loan:___________ Loan No.__________ b. Original principal amount of the loan: $___________ c. Was the loan used to improve this property? __Yes __No

Section I. APPLICANT(S) INFORMATION Name of Applicant

Age

Address (Street, City, State, Zip Code)

Social Security No. or Tax ID No. How Long

Home Telephone Number ( ) Name of Co-Applicant, if any:

Age

Marital Status: __Married __Separated __ Unmarried (including single, divorced, widowed) __ N/A

Name and Address of nearest relative not living with you

Relationship

Telephone Number ( ) Social Security No. Marital Status: __Married __Separated __ Unmarried (including single, divorced, widowed) __ N/A

This information is requested solely for the purpose of determining compliance with Federal civil rights law and your response will not affect consideration of your application. __ Male __ Female

1. __White 4. __Asian or Pacific Islander

2.__Black 5.__Hispanic

3.__American Indian or Alaskan Native

Section II. INCOME AND ASSETS * The only income standard you must meet is to demonstrate that you have sufficient income to repay the loan. * Disclose this income, and provide evidence of receiving it (eg. recent tax return, check stub, etc.) * If the loan is secured by a mortgage, all entities having an ownership interest in the property must generally sign the mortgage. Complete this section if the applicant and owner of the property is a natural person. 5. EMPLOYMENT AND SALARIES (if applicant is self-employed, submit current financial statement.) Employer Name and Business Address Type of Work or No. of Business Phone Position Years Co-Applicant’s Employer Name and Business Address

Type of Work or Position

No. of Years

Salary (week/month): $ per Salary (week/month):

Business Phone

$ per Amount (week/month):

Other Income-Source (Note: Income from alimony, child support, or separate maintenance income need not be shown unless you will rely upon it as a basis for undertaking or repaying this loan.

$

per

If the applicant and owner of the property is not a natural person, provide a copy of the applicant’s most recent financial statements or federal tax returns. Section III. CREDIT INFORMATION A. CREDIT HISTORY These questions apply to all applicants. If you answer “yes,” provide a separate written explanation. Are there any outstanding judgments or liens against you? __Yes __No Have you been declared bankrupt within the past 36 months? __Yes __No Have you had any property foreclosed upon or given title or deed in lieu thereof? __Yes __No Are you a co-maker or endorser on a note? __Yes __No B. DEBTS List ALL current fixed obligations, mortgage, and contract for deed payments, installment accounts, revolving charge accounts, loans, and debts to banks and finance companies. (If more space is needed, list all additional debts on attached sheets.) To Whom Indebted (Name)

City and State

Account Number

Monthly Payments

Present Balance

Original Amount

Date Incurred

Mortgage:

$

$

Contract-for-Deed:

$

$

IF TAXES AND INSURANCE ARE NOT INCLUDED IN YOUR PAYMENT, INDICATE AVERAGE MONTHLY AMOUNT:

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

Check if Businessrelated

Section IV. PROPERTY INFORMATION Address of Property to be improved: Street:

City:

Zip:

County: 1. The age of the residential property to be improved is ______ years. 2. The purchase price of the property was: $_____________. The date of purchase was: _____________ 3. The current Estimated Market Value of the property from my Property Tax Statement is: $_____________ 4. The number of dwelling units contained in the property to be improved is: ______ 5. Is the property being purchased on a contract-for-deed? __ Yes

__ No

If Yes: is there a “balloon payment” on the contract-for-deed? __ Yes

__ No

What is the date of the balloon payment? _______________ What is the amount of the balloon payment? $________________ Section V. IMPROVEMENTS Type of Improvement

Estimated Cost

Name of Contractor

Potable Water Heater Repair/Replacement Heating System Replacement AFUE:___________ Heating System Modification Wall Insulation Attic Insulation Foundation Insulation Storm Windows/Doors Other (specify:________) House Doctor (if applicable) High Efficiency Lighting Total Section VI. CONDITIONS PERTAINING TO RECEIVING A RENTAL ENERGY LOAN a) Loan funds shall be spent for the intended purposes within 90 days from the date of the Note. b) The Lender, or its representatives, shall have the right to inspect the property to be improved at any time from the date of application upon giving due notice to the owner. c) Borrower is required to submit Social Security number as part of this loan application. Your social Security number may be utilized for debt collection purposes under the Minnesota Revenue Recapture Act of 1980. d) Loan must be closed with lender prior to any work beginning. Work started before the loan closing may not be financed. e) Borrower(s) must have at least one-third ownership in the property to be improved. Section VII. SIGNATURES a) b) c) d)

I/we certify that the statements contained in this application are true, accurate, and complete to the best of my/our knowledge. I/we agree to the above Conditions Pertaining to Receiving this loan. I/we hereby authorize the release of any information necessary for the lending institution to process this application. I/we certify that I/we have not been suspended or prohibited from receiving Federal Funds.

Applicant

Date

Co-Applicant

or Signed: Print Name:

Title:

Representative:

604/forms/relfapp.doc